Diabetes Archive

For a long time I had this odd sensation inside: I didn’t feel at one with myself, but I couldn’t put my finger on why. There were many possible contributing factors: private, personal, mental, physical, and professional.

I guess it all came to a head in October 2008. We (the family) lost someone very special that month; it was a loss that cut me very deeply, more than I was prepared to acknowledge at the time.

The months after the funeral – leading up to Christmas – was a numb procession, and I attributed my dark, unpremeditated mood swings and the feeling of cold resentment and disdain towards the world to the unremitting grief that I was enduring. I had not been eating well; I connected the drastic weight loss to grief.

I was learning to drive and would have been taking my test in January. I was blaming the shifts for my lapses in concentration when driving, and the driving for my indolence during shifts – feelings of lethargy are habitual for any shift worker. My bouts of insomnia were, I believed, answerable to the relentless shift patterns as well.

I was aware that my eyesight had gotten blurry and I was getting frequent headaches – I stare at over 200 CCTV screens for a living, who wouldn’t get a sore head and square eyes from doing that?

The air in workplace can be quite dry; it is common to get thirsty. It was only until I was drowning myself with pint after pint of water, thirst un-quenched, that I realised something was wrong. My voice had lowered over the space of weeks; gruff growls and phlegmatic rumbles, as if gargling wall tacs.

My throat was inflaming and I was experiencing persistent pains, like barbed wire had encumbered my tonsils. Again, there was a probable explanation: several of my colleagues had succumbed to a lingering flu bug and had simply spread the love to me.

It was during the 2008 Christmas period that I rapidly deteriorated. I was feeling tired, incensed, and confused. My family (of nurses) thought that I had, ‘come down with something’ (weren’t they right). I had no interest in Christmas at all – or anything else in life. During the dull festive period I was happiest when retreating to work or having driving lessons; where I could find focus on the job at hand. I was clearly not myself.

For weeks I had been snapping at my girlfriend and arguing with colleagues for no reason; generally behaving like a prepubescent teenager, realising my actions through the punishment of hindsight. I can be a miserable bastard anyway, but these moods were darker; out-of-the-blue. I had also been enduring the same headache for over a month. Something wasn’t right.

My 30th birthday celebration consisted of me, my girlfriend, and a mutual friend meeting up for a meal and drinks in Cardiff – I didn’t crave for much else in the way if social interaction. By 7 o’clock I had abandoned tequila and was drinking tea. By 8 o’clock I was ready for pipe and slippers. Anyone who knows me with testify that I am always among the last revellers to fall. And I still had that damn headache.

It took two weeks to get an appointment with the doctor. I was getting worse by the day. Finally, after enduring an eight hour night shift, I arrived at the local surgery. Following an examination I was abruptly admitted to hospital.

My keytone levels were dangerously high and I had registered one mother-and-father of a blood glucose reading: 30 mmol – A nurse shouting ‘Bloody hell!’ is always the first hint that something is amiss.

Tired and confused, I contacted the relevant family members for a lift to hospital and started to pack my overnight bag. I didn’t have a clue what diabetes was; I was hoping that they could have it sorted in a few weeks.

Ignorance would not be bliss. The wait at the hospital was over 3 hours. By this point I had been awake for over 24 hours, and was feeling it in every part of my forlorn, fragile body.

Finally, I was allocated a bed to not sleep in. Various pricks, prods, pokes, and consultations; pretty student doctors telling me to piss in ugly jars. It was getting too much. I started getting quite worried when they attached some sort of heart monitor. All that talk of kidney and liver functions was quite unsettling, too.

Hospital curtains are not soundproof, but medical staff must be genetically altered to believe they are. I was trying very hard not to get salty with the staff; they helped me achieve that by simply ignoring me. I just wanted to go home, close my eyes, and sleep.

Men are funny creatures: On the bed of reckoning; tired, panicked, fatigued, and sedated; connected to drips, and whatever else was sticking in and out me, and I still had time to eye-up the nurses. Pepé Le Pew lives in my libido! Eventually, some smartly dressed doctors approached me. My initial thoughts at the time were ‘Don’t look at me all fucking jolly and smiling!’ But they did.

While looking at me all fucking jolly and smiling they told me that I have Type 1 Diabetes. I would have to inject insulin for the rest of my finite existence. A new full time job; without pay or leave entitlements. No promotion prospects and the daily potential threat of termination – of the terminal kind.

It’s surreal to think back to that life-defining moment. While the specialists were telling me the most important, life-changing news, I was formulating a cheesy James Bond sketch in my head:

A rather attractive nurse approaches me and says, ‘please lift up your t-shirt so I can examine you.’ Mere seconds later, I’m sat up in bed wearing nothing but a dazzling white towel robe, pouring two glasses of champagne. A single red rose peers over the deck of a silver ice bucket. ‘Would you care for some caviar?’ I ask, lifting a seductive eyebrow, ‘An hors d’œuvre, perhaps?’

The sleep deprivation and denial had settled in; sheer disbelief and refusal to face the reality: that diabetes is for life. Always. For ever. Longer than a little while. No cure. A bit of a pickle to say the least, old chum.

I was discharged the same night and was instructed to return the following morning to learn to inject myself and test my levels. This was followed by a consultation with the dietitian who would convert me to fruit, veg and other alien foods.

I strongly recollect having best night’s sleep that I can ever remember having. I woke up feeling new, sharp and focused; no longer high. Had I not been myself for so long that I had forgotten what ‘being myself’ felt like?

Answers were coming ten-to-the-dozen: I had been suffering with high sugars for a long time. Whenever I consumed a hearty lunch my eyes would feel like they wanted to spin around like the slots in a fruit machine. I would feel especially tired after eating rice, pasta, and potatoes.

During the weeks leading up to my diagnosis I was quenching my thirst with orange juice and tea with the usual two sugars – sugars! I was eating healthy: rice, pasta, and potatoes – carbohydrates! I was beginning to think that I was lactose intolerant because I always felt sleepy after eating cereals and things with cheese, like pizza – pizza and cereal are high incarbohydrate!

I took to injecting quite quickly; my survival instinct had kicked in at this point – subconsciously absorbing this new information. The lecture from the dietitian didn’t sink in, however. Irony is me contracting a disease that involves maths: I’m one of the 5-in-4 people who has problems with fractions!

I was given a semesters worth of books to study; addressing cheerful subjects like blindness, neuropathy, ketoacidosis, heart-kidney-liver failure, amputation, hypers and hypos. “Erectile dysfunction? What the bloody fuck?”

The specialist had written down how much I was to inject myself with, but I didn’t have a clue how much to eat – and I was too dumbfounded to ask. I was still drifting in a haze of denial; yet to be blindsided by the brutal realisation. But it wouldn’t be long before that freight train rolled in.

Later that evening I was sobbing over a lonely breast of chicken and a heap of steamed broccoli. It was as if every bereavement and breakup I had endured in my life had reunited and was dragging my guts across a bed of hot coals; littered with shards of glass, ghost chilies, and Lego.

I felt like I had been betrayed by myself. And I failed my fucking driving test. After reading the study notes of my condition, silly things started running through my mind – the desperation phase:

I began looking for miracle cures on the internet; kidney and pancreas transplants. I didn’t ask for diabetes to enter my life; this disease that would always there when I woke up and the last thing on my mind before Morpheus lured me to outlandish realms.

By design I am a fighter; I take the blows that life hits me with and bounce back stronger. I am a control freak; living my life the way I want to. Over the years I have come back stronger and found positives: I passed by driving test and I worked out my carbohydrate-to-insulin ratio.

I attended a diabetes course where I proved to myself that I was doing everything right; I have become friends with other diabetics and learned from their experiences.

I am at a point where I no longer feel restricted by my diabetes; I just have to think about things a little more; plan ahead. I make more time to observe and learn about the world around me; to live the dream and enjoy the smaller, more pleasant things on this pale blue dot!

Much has been said about rapid insulin and the positive benefit it has had on diabetic control over the last decade. Background – or long-lasting insulin – also plays a part in maintaining a complex balancing act.

The human body produces a constant flow of its own glucose called glycogen. This glycogen production is normally counterbalanced by the pancreas; which produces just enough insulin to break down the glycogen – for normal people, anyway.

A type 1 diabetic has no natural means insulin production to counterbalance the glycogen production – so we need to inject insulin into our bloodstream. In addition to injecting rapid insulin, diabetics can inject long-lasting, slow release insulin. This background insulin lasts up to 24 hours (rapid insulin lasts up to 4 hours). Its main purpose is to assist in balancing the body’s natural glycogen production.

When I was diagnosed with type 1 diabetes I was put on a set dose of rapid insulin (Novorapid) and background insulin (Levmir). As previously documented in this blog I quickly worked out my carbohydrate to rapid insulin ratio, thus improving control of my glucose levels.

Despite this breakthrough I was finding that even when the rapid insulin was not present in my bloodstream – after a long sleep, for example – I needed to consume 20 grams of carbohydrate every few hours to prevent my levels dropping too low. I eventually discovered it was because my background insulin dose was too high.

During a concert one evening I easily consumed over 60 grams of carbohydrate – the equivalent of a main meal – over the course of two hours without taking any rapid insulin; my blood levels did not raise above ‘normal’ levels during the whole time.

Standing up for long periods consumes energy, but not to the degree where I’m required to carry a bakery in by backpack! After a brief consultation with the Professor of Diabetes at my local hospital I was encouraged to experiment with by background insulin levels.

My initial dose of background insulin upon diagnosis was 16 units. Every week I would reduce this by 2 units to see how it affected my day-to-day routines. My method was to spread out my meal times so that the rapid insulin would be absent from my bloodstream at certain times of the day – preferably when I was resting.

I would then test my glucose levels every few hours to determine if my levels were still falling without the aid of the rapid insulin. The final test was to eat a zero carbohydrate breakfast – like chicken or scrambled eggs. If my glucose levels continued to fall during the course of my morning routine, then further adjustment was required. I kept this up for a few months.

At present my background insulin dose is 8 units – half the dose set by my diabetic specialist. I no longer need to snack every 2 hours – which has helped with my diet – and I sleep better knowing that I am less likely to get woken up by a hypo.

Over the years, through experimentation, I discovered that less background insulin is needed during hot summer months. In colder weather I increase my doses – though not as high as first prescribed.

The pay-off is that I now have to take a few units of rapid insulin when consuming some snacks that the background insulin would normally have coped with by itself. But it’s a small price to pay for more freedom and less food!

After a few months as a newbie diabetic, I discovered my carb-to-insulin ratio. It was all thanks to a man named Clive and a Cumberland pie:

A lot of things are taken for granted in life; things like walking, talking, breathing, and whiskey. It’s only when those things are compromised that you realise you couldn’t function without them. Cruelly, for a diabetic, one natural and satisfying act in life is also one that demands the most care: the simple act of eating.

As a Type 1 I have to be more conscious and careful with my meal portions – ‘All things in moderation’, as my late Gran would say. For diabetics diet is all about carbohydrates and sugars – just like time and space is relative, so are carbohydrates and sugars. I’ve never had a sweet tooth and have always maintained a balanced diet; in that respect I am quite fortunate.

Five out of four people have problems with adding-up, and I am one of those six people. In the early months of diabetes I struggled with counting carbohydrates, especially pasta and rice. I was practically living off ‘healthy living’ microwave meals and Kellogg’s variety packs because the nutritional contents were printed on the back.

My overall feeling was that if I couldn’t eat, drink and be merry, then just measure me up, lay me in a wooden box and feed a thousand worms me for Christmas. I was on a fixed insulin dose of insulin per meal and was advised by my dietician to consume around 50 grams of carbohydrate per meal. So I did just that. Two hours after food my target blood glucose levels were always between 5-7 mmol – where a ‘normal’ person’s levels live.

But, it was getting to the point where I was eating to stay alive and not getting any pleasure out of it. During night shifts I don’t get very hungry, so instead of one large meal I take bread rolls. Rolls are around 25 grams of carb each – half of a main meal. I found that by halving my dose to 4 units per roll I was achieving the same target blood results (5-7 mmol).

On one afternoon shift I was talking to my work colleague, Clive, about my food dilemma. ‘What you’ve got there is the six times table’, he said. I stared at him, confused; as if a Berman cat had just materialized on his head. He continued, ‘4×6 is 24, and 8×6 is 48.’ The Berman coughed up a fur ball. ‘For 24 grams you take 4 units, and for 48 grams you take 8 units…that’s close to the six times table!’

The Berman cat caught, and toyed with a small vole. ‘If you were to eat something containing around, say, 36g of carb, then wouldn’t you require 6 units?’ The Berman put on a top hat and leapt into the air in triumph; performing a rather slickCharlestonroutine.Eureka! (Meow!)

Later in the shift I headed with purpose to ASDA and purchased a Cumberland Pie containing around 36g of carb and dosed as per six-times-table. A few hours after eating it I was within my target blood glucose range.

Over the next few days I experimented like a hippy in Amsterdam with different meals of varying consistency containing different carb contents, and achieved some far-out results. My insulin-to-carb ratio – or ‘food mojo’ – is around 1 unit for every 6 grams of carbohydrate I consume. My diet – within reason – is whatever the hell I want it to be.

I can’t help but feel that I am tugging the capes of the more seasoned diabetics when writing about my relatively short lived experiences – nobody likes a smartarse, do they? But, had I been diagnosed over 10 years ago, my arse would not be so smart. My diabetes is easily manageable because of the development of rapid acting insulin. I am a diabetic smartarse because of scientific smartarses.

Rapid insulin does exactly as it says on the veil: it rapidly enters the bloodstream and breaks down glucose that is released into the body from food. If a certain diabetic smartarse is able to calculate how much insulin to inject in relation to how much carbohydrate he consumes, he would be capable of sustaining his blood levels at near-normal levels for most of the time; greatly reducing the likelihood of future complications.

Before the implementation of rapid insulin, sugar levels ran higher for longer; complications such as deteriorated vision, liver and kidney damage, stroke, amputation, heart disease, nerve damage and trouble ‘getting it up’ were more common.

A few months after diagnosis, I attended a course at my local hospital on how to become a smartarse at manage diabetes in everyday life. A woman on the course was in her late 40’s and had been diabetic since her youth. She observed that what was being taught on the course was, at one time, the exact opposite to the way she managed her diabetes twenty years ago – before rapid insulin.

Back in the dark ages of glass syringes, regimes were more militaristic; one insulin injection lasted 12-24 hours. Meals had to be eaten at set times and carbohydrate counting was a required science. Unscheduled eating would cause sugar levels to rise, and there wasn’t an easy way to lower them. Diabetes, back then, was like treading an invisible, constantly-moving tightrope.

Diabetic control has been made easier today; thanks to scientific smartarses making rapid insulin possible. Diabetes is centered around our lives, now. I am not limited to how much I can eat, or how many rapid insulin shots I can inject myself with. If my glucose levels are high, I simply inject a corrective dose.

The risk of complications may be greatly reduced, but they have not been totally eradicated! Diabetes is, and always will be, a chronic condition that must be managed with great care and responsibility – it is a life partner that demands a certain degree of give-and-take.

With the relatively new introduction of the insulin pump and the positive progress being made by medical smartarses, there are some potentially life-changing developments on the horizon, like oral insulin pills, an artificial pancreas and the re-coding of beta cells that attack internal invaders (like replacement organs).

Who knows, maybe in 20 years from now people with diabetic symptoms may only require a course of tablets: ‘Remember, take two-a-day for three weeks, avoid cake, and you’ll be as fit as a fiddle in no time.’

A trip to London’s south bank resulted in my first public encounter with another diabetic (Written in 2009).

My girlfriend and I had spent the day at the Christmas markets in London’s Hyde Park; and later at the South Bank where we stumbled upon Las Iguanas – a South American themed cocktail bar that, once upon a time, served the best Tequila Sunrises this side of Saturn.

Las Iguanas have since decided to scrub Tequila Sunrises off the drinks menu – which is like Severn Trent Waterdeciding not to supply H2O anymore. In all fairness, though we asked if they could mix us some Sunrises anyway, and they did – at happy hour prices, too!

I did have get narky with one of the bar staff at one point; he decided that he would only serve Tequila Sunrises in pitchers – priced at un-competitive mortgage rates. I assertively remarked that this was our third call to the bar – for the same drink – and challenged him to explain his sudden shift to the right-wing of bar politics.

Upon my triumphant return to our table, another couple had perched themselves on the sofa beside us. I noticed that the blond girlfriend who was injecting into her right arm, using something that looked familiar: it was the same insulin pen that I use.

“Excuse me,” I asked, holding my own insulin pen aloft; like a secret hand shake of the Freemasons. “Are you Type 1?” She smiled and nodded. I couldn’t help but give a wry grin at her response when I told her that I was a recent type 1, “How’s that working out for you?” It was like a prison inmate asking another prison inmate ‘what are you in for?’

The diabetic I had just introduced myself to was named Lucy. She was 24 years old and had been ‘doing her time’ since the age of 11 – just as she should have been starting to enjoy the fruits of life. Lucy and her boyfriend, James, were out on a day trip toLondonin an attempt to ‘do something cultured’ with their day.

After a while we began swapping stories and comparing our likes and hates of our disease; like the overwhelming temptations of certain foods – and, generally, the general unfairness of it all. We soon discovered a mutual adoration for adopting spirits as a coping method – well, spirits are sugar free!

Naturally, being so young, Lucy took the news of being insulin dependent quite hard and constantly rebelled against her diabetes; stubbornly doing the same things as her friends, only to end up getting incapacitated by hypos. She even secluded herself from the other diabetics at the local clinic; resenting being viewed as different from her friends.

Lucy’s gung-ho attitude was swiftly rectified at the age of sixteen when she found herself in hospital as a result a severe hypo. Lucy recalled hearing her mother asking the doctor if she was going to pull through; the doctor simply shrugged his shoulders.

It was during that brief spell in hospital were Lucy acknowledged the fragility of diabetes – how easy it is to kill yourself without trying. It was the wake-up call she needed and has since grabbed the diabetes bull by the horns.

She still goes off the rails from time to time, but she is still young and comes across as mature enough to understand that anything can be enjoyed in moderation. I have since met a few other diabetics who were diagnosed quite early in life; I can’t imagine how restricted they must have felt during the times when rebellious instinct was at the forefront of their adolescence.

I was diagnosed quite late in life and had already enjoyed my rebellious teenage years in pirate fashion; drowning myself in murky, snakebite infested waters and high spirits; chocking on the thick layers of fog as I passed duchies on the port side.

I have since become far too cautious for my own good; even my diabetic nurses feel the need to persuade me that it is okay to ‘let go of the reigns every now and again’. Meeting and talking to people like Lucy has definitely helped me come around to their way of thinking.

Lucy told us that her handbag had recently been stolen, containing the essential glucose meter and insulin pen. While waiting for a replacement glucose meter she was getting by on sheer guess-work. Lucy’s improvisations had recently resulted in a nasty ‘episode’ on a tube train; I had a similar experience.

Lucy’s boyfriend, James – who eventually managed to get a word in – works with dogs. He provided a fascinating insight into the new training techniques being developed for medical benefits, including ‘hypo awareness dogs’ for people with poor diabetic control.

Happy at having had his chance to speak, and Lucy finding that her cocktail glass was empty, the couple set off on their cultural adventure. After all the help and advice she gave me, I felt like should have offered something in return, but the only helpful thing that sprung to mind at the time was, ‘don’t go to the Tate, it’s really shit’. So, I wished them well on their adventures and returned to the bar.

As a type 1 diabetic I am examined on an annual basis. It’s a bit like an end-of-term report, but without the cheating. These tests are designed to assess my liver & kidney functions, weight, cholesterol and average blood glucose levels – and to detect and prevent the many occupational hazards that come with being pancreatically challenged.

When I was first summoned to the local GP for my end of term blood test, I was required to fast for ten hours prior to my appointment. This was daunting for me because I’ve never fasted before. I was conscious that I could go hypo in my sleep. There was also the added complication of shift work; which has varying affects on metabolism and sugar levels.

I worked a way around this dilemma by only taking half of my meal insulin before bed. By morning my blood levels were still high enough not to spring any surprises. I arrived at the doctors, promptly late, and presented the nurse with an early morning urine sample – it still pains me to know that I’ll be filling those little samples for the rest of my life.

A few weeks later I returned to discuss the results with my practice nurse. We had met before, but she couldn’t remember; that was until she looked at my results; apparently, I’m their best student. I was delighted to be told that my cholesterol, blood pressure and Hb1Ac were bang on target. She then examined my feet –which could have wilted a cactus.

What I was not prepared for were the concerns the nurse seemed to have about my tight diabetic control. She appeared under the assumption that I was letting my diabetes control my quality of life. I immediately jumped to my defense and argued that I keep good control of my diabetes because I know my routines and I am playing the long-game.

She gave me a suspicious gaze; like that of a wife whose husband claims he reads Playboy magazine for the cutting-edge journalistic content. I returned her gaze; like that of a husband about to tell his wife that he really reads Playboy magazine for the tits. I began telling her how much of a committed perfectionist I am by nature; that I’d gotten the hang of diabetes quite early and that I am in no way restricted by my condition.

By the second month of becoming diabetic I had perfected my own routine. I recall having a conversation with my mother during that time in which she said, “So, you’ve decided to disregard the advice that the specialists have given you and do things your own way? You are definitely my son!”

I pointed out to the nurse that if diabetes was controlling my life then I wouldn’t have started going to more concerts and other events; I wouldn’t have passed my driving test or began travelling to other countries again. I wouldn’t be enjoying a new-found appreciation for fine food or sipping Tequila Sunrise under the Cardiff sunlight; seemingly freeze-framed as the frantic rat-race unfolds around me.

I wouldn’t have started writing, or perused hobbies that have enhanced and enriched my life; changing my overall outlook; my sense of identity, my beliefs, my philosophies. I wouldn’t be the unique, balanced and grounded individual that I am today.